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General NPI Number Information
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NPI Number | 1093088247
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Entity Type | Individual
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Provider Name | SUSAN A MCDERMOTT PMHNP, FNP
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Gender | Female
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Dates
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Enumeration Date | 02/20/2012
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 7 HEMPHILL PL STE 232
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City | BALLSTON SPA
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State | NY
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Zip | 12020-4482
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Country | US
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Telephone | 838-202-4296
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Fax |
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Provider Business Mailing Address
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Address Line | 7 HEMPHILL PL STE 232
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City | BALLSTON SPA
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State | NY
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Zip | 12020-4482
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Country | US
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Telephone | 518-588-2930
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F337084-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F403054-01
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License Number State | NY
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